Speaker Key:
TE Dr Tedros
RS Professor Robert Steffen
MR Dr Mike Ryan
TJ Tarik Jasarevic
ST Stephanie Nebehay
JL Jérémie Lanche
BM Betsy McKay
PD Pam Das
LS Liza Schnering
DM Donald McNeil
TJ Good evening again, from Geneva Head Quarters. My name is Tarik Jasarevic. Thank you very much for your patience. We will start immediately with a press conference following the fifth meeting of the Emergency Committee regarding the Ebola outbreak in the Democratic Republic of the Congo.
Before I give the floor to our speakers, I will remind you that we will have a transcript from this press briefing later tonight, and the audio file, immediately following the press conference. For those who want to ask a question, please type, 01, on your keypad, and you will be put in line to ask questions. I would also like to remind those listening that this press briefing is webcast live on WHO Twitter account.
Today with us we have Professor Robert Steffen who is the Chair of the Emergency Committee. We have Dr Tedros, WHO Director-General, and we Dr Mike Ryan, Executive Director, WHO Health Emergencies Programme. So, we will start immediately with Dr Tedros, who will give opening remarks. Dr Tedros.
00:01:04
TE Thank you, Professor Steffen. Good evening everyone in the room and to everyone online. First of all, I would like to thank Professor Steffen once again, for his leadership of the Emergency Committee, and all the members of the Committee, the advisors and those who made presentations earlier today. As you have heard, the Emergency Committee has recommended that the current Ebola outbreak continues to pose a Public Health Emergency of International Concern. I have accepted that advice.
00:01:49
So, the Public Health Emergency of International Concern status will be maintained for an additional three months. The Emergency Committee will be reconvened within three months to reassess again. This outbreak remains a complex and dangerous outbreak. We need the full force of all partners to bring this outbreak under control, and to meet the needs of the people affected. However, we should all be pleased with the very impressive progress we have made since the committee last met.
One of the concerns with declaring PHEIC is that some countries may impose unnecessary restrictions on travel and trade. We’re very pleased to note that, so far, no country has done that. After the declaration of the PHEIC, we implemented a 90-day plan to accelerate our response. Together with our partners, we have expanded screening and contact tracing. Strengthened infection prevention and control, and intensified preparedness efforts in neighbouring countries.
We have also adapted security measures to protect health workers while improving community trust and deployed a new data collection tool. We have implemented several new vaccination strategies which have resulted in doubling the existing vaccine supply, allowing for more than 230,000 people to be vaccinated.
So far, these efforts are working. We have contained Ebola in former hotspots, such as Beni, and successfully prevented onward transmission in Goma and Uganda. The number of cases has declined each week for the past four weeks. Last week there were just 15 cases, compared with the peak of 120 cases during one week in April.
00:04:08
But this encouraging trend should be interpreted with caution. Although the outbreak is now concentrated in a smaller geographic area, that area is more rural and difficult to reach. We must treat every case as if it’s the first because every single case has the potential to spark a new and bigger outbreak. We’re actually continuing to increase our efforts. Until we reach zero cases, we’re in full response mode.
Security continues to be a major concern. We cannot end this outbreak without a conducive environment in which health workers can safely access the people who need their help. The risk of spread within DRC and to neighbouring countries remains very high. And we continue to face funding constraints.
So far, we have received half of the money needed to maintain response efforts to this outbreak. That puts health security, across the globe, at risk. In addition, funding for preparedness in surrounding countries is grossly inadequate. This is dangerously short-sighted, and frankly, difficult to understand. If we fail to prepare, we’re preparing to fail. We must fix the roof before the rain comes.
And even as we focus our efforts on ending the outbreak, we must all see the bigger picture. Although it preoccupies the world’s media, Ebola is just one of numerous threats that the people of North Kivu face every day. Malaria and measles are killing more than Ebola. WHO’s commitment is to supporting DRC to strengthen its health system, at the foundation of a healthier, safer and fairer DRC.
00:06:20
Finally, I want to thank all the brave responders, the Congolese responders, and partners, WHO colleagues, who continue to put their lives on the line every single day. We owe it to them and to the people they serve, and to devote ourselves to ending this outbreak as soon as possible. Thank you very much for joining.
TJ Thank you very much, Dr Tedros. Professor Steffen, would you like to say a few words?
RS Sure. Good evening. The Ebola Emergency Committee recognised with great satisfaction, the progress made in the past six months. And as Dr Tedros mentioned, the numbers per week of confirmed cases came down from 128 to 15.
Additionally, it was noted, particularly that there was an improved preparedness in high risk neighbouring countries. There is better transparency in reporting by most countries, and as you mentioned already Dr Tedros, there are no restrictions on travel and trade.
And additionally, there was one good news today, and that is that European Medicines Agency recommended on conditional marketing of the Ebola vaccine, the Merck vaccine.
00:07:59
Nevertheless, as it has already been mentioned, the Ebola Emergency Committee recommended that the PHEIC be maintained, Public Health Emergency of International Concern. Because the battle is not over yet. And as it was alluded to, we must remain cautious. There might be setbacks, and for me, this outbreak is like a marathon, and the last mile is always the most difficult.
There have also been some concerns in the Emergency Committee, and the insufficient funding has been mentioned, and I think that we all need to acknowledge that this is an investment into the entire world, if funding is granted. Occasionally there have been some delays in communications, and there have been continued problems with security at the new hotspots in Mandima and Mambasa.
The recommendations which you have in detail in your print outs have been slightly adapted. Let me just mention two examples. We want, in future, to establish a community awareness, as well, in areas where there has been no transmission so far, with the hope that of course there will never be transmission. But we need to be ahead of the crisis, and additionally, we also want to accelerate comprehensive action for active surveillance for cases and unexplained deaths in all areas. So much from my side. Thank you.
TJ Thank you very much, Professor Steffen. We will now open the floor for questions. For those online, please type, 01, on your keypad to be able to ask your question. Those watching us on Twitter can also leave a question. I will start here with the room. Are there any questions from journalists here in the room right now? I don’t see any. Stephanie, please. Please press the botton.
00:10:31
ST Stephanie, Reuters. I’m not sure who this should be for, perhaps for Mike. In terms of the cases known or suspected in that mining area of Mandima, how good of a handle do you have on that situation? What is current access, please? And how do you see the virus spreading or evolving there at the moment?
MR We’ve surged stronger teams into the Biakato Mines area over the last two weeks, with a lot more supervision of field teams, but the access to the communities there is compromised, given both the terrain and the difficulty. There’s both legal and illegal mining in that area. We are using community health workers and rallies at the community level, to provide information.
So, we have been involved in very deep negotiations with the local community, working with MSF, working with UNICEF and others, and we believe in… Now, we are beginning… Actually, you’ve seen the cases over the last week. We believe that’s the result of increased surveillance, but I do believe there’ll be further cases to be found in the Biakato Mines area. And you are correct, the area is that remote and the communities are that deep in the countryside that it will be another week to two weeks before we can be sure that there’s not undetected transmission. And that’s all.
00:12:12
TJ Thank you very much, Dr Ryan. Now we will start taking questions from journalists online. We’ll start with Jeremy. Jeremy, can you hear us? Can you introduce yourself in the media?
JL Yes, thank you Tarik. Jérémie Lanche -RFI. A couple of questions. The first one is, I would like to understand how is the licencing of the Merck vaccine, by the European Agency, a game-changer for Congo? How is it changing anything for you on the ground?
The second question would be about, what Dr Muyembe said, that at the current pace, it would take three or four months to eradicate Ebola. So, would you agree with that statement? And the final question will be about, Tanzania and Central Africa. Central Africa denied that any further cases were found on the territory. Do you have any indication, anything to confirm or not, about those countries? Thank you.
TJ Thank you very much, Jérémie. Dr Ryan?
MR Yes, with regard, Professor Steffen has already referred to it, the conditional decision today, which will push the vaccine forward to the European Commission for formal approval, is a major milestone. And a major step in a journey of a thousand or more steps, that has been travelled by many institutions together.
Public institutions, starting with the development of the vaccine by the Canadian Government itself, the involvement of the private sector, the engagement of multiple scientific institutions. The countries like Guinea itself, and Congo at government level, both getting deeply involved in the process of testing the vaccine.
00:14:08
So, this has been a long journey of innovation, and one thankfully targeted at delivering a solution for vulnerable people. Something made available to those who need it in a high impact epidemic. So, I think it represents the vision that WHO has, to bring those products to the market and to people. And in that sense, it is a game-changer, but it’s but one more step.
We will continue to use the vaccine that we currently have, under the protocol we’re currently using. And in fact, the licencing of the vaccine will impact on vaccine supplies and stocks that will come through next year. So, no change at the moment to the use of the vaccine, but a great welcome for the arrival of this latest decision. And congratulations to all those involved. I’m sure those congratulations are echoed by Dr Tedros, who may wish to comment on that at the end.
In terms of predicting timelines for epidemics. I’d be… Professor Jean-Jacques Muyembe has forgotten more about Ebola than I will ever probably ever learn, so I would not like to question Professor Muyembe’s predictive capacities. I, like Dr Muyembe and WHO, like Dr Muyembe, believe that we are on what could be a bumpy road to zero. But there is no zero risk without zero Ebola. And as Dr Tedros has said, there is great danger associated with becoming complacent at this point. So, I will avoid predictions.
If we continue to drive as well as we have, over the last two to three months, and if we continue to chase the virus and get ahead of the virus, then I believe the outbreak will come to an end. It will come to an end - 42 days after the last confirmed case, so let’s try and push towards that.
00:16:03
The last question was about South Africa and Tanzania. Yes, on Tanzania, it’s been over 40 days since we had reports of a suspect case in Tanzania. We continue to work closely with Tanzania on issues of preparedness and supporting their capacities to respond to Ebola or any other haemorrhagic fevers. And in fact, the Government of Tanzania updated the committee today on their preparedness activities, and Professor Steffen can comment on that.
So, the one thing, and there have been, I know, many criticisms around the lack of full information provided by Tanzania, and that has been a frustration for WHO. But what we would like to focus on is the remarkable transparency and cooperation shown by so many countries directly in the frontline of Ebola.
The nine countries surrounding, the countries, as the professor…as the DG outlined in his speech, who haven’t imposed sanctions on the Democratic Republic of Congo. I think we’ve seen a remarkable shift in the way in which the international community is prepared to cooperate and work together and share collectively the responsibility for managing epidemics and their economic and social consequences.
00:17:25
And in that, we call on all countries to be as transparent as possible in that process, and we will continue to work with those countries to ensure that they’re prepared and ready for whatever comes their way.
TE Maybe on… I will just add a few. Mike had already covered it. On the vaccine, first of all, we’re really proud to partner with the Government of Guinea. In 2015, actually, WHO and the Government of Guinea to start the study, and now the fruits of it is coming.
Then second, from EMA side, the European Medicines Agency, although it gave the conditional approval now, we expect that before the end of this year, that will be their licencing. And side by side, as WHO, we’re working on pre-qualifications, and then, of course, registration by countries from Africa, so it can be used quickly. So, we’re preparing to use it, based on the licence.
Then, on when this Ebola will end. It will end, and we’re giving it our best, but one thing I would like to underline here is, even if this Ebola ends, it may come back again because the preconditions are there. There is instability in Eastern DRC, and there is political instability and there is lack of security. And these are preconditions for Ebola to come back.
Then the health system, as a result of conflicts of more than two decades, is weakened. It’s like it doesn’t exist, so that also is another precondition. So, for us, what is worrisome is, it’s not just ending now. We can end it, but it may come back again. So, we have to invest. Not only to fight this outbreak, but we have to start investing for the future too. So, that’s very important.
00:19:45
In terms of when will it end? No need to speculate, because the area, as I said, is a very complex area. It’s a very volatile area. We have made significant progress, recently, and the number of cases has plummeted, but if there is a security incident, it may happen, because there are many rebel groups in the region.
If there is any incidence in security incidents, we may lose what we have gained so far. So, that’s why we refrain from speculating. And we believe that we should give it our best, and target to end it, but refrain from speculating. So, these are the two, I think, additions I would like to make.
RS Nothing to add.
TJ Thank you very much, Dr Ryan and Dr Tedros. Just before we go to the next question, just to remind you to type, 01, on your keypad, and you will be put in line. Also, we have just sent you the official statement from the Emergency Committee Meeting. We will now go to the Wall Street Journal, and I apologise if we don’t get names right. Can you just introduce yourself, please?
UF Yes, hi, can you hear me?
TJ Yes, not very well. If you can speak just a little bit louder.
00:21:15
BM Okay, I’ll try to speak a little louder. This is Betsy McKay from the Wall Street Journal.
TJ Hi Betsy, please go ahead.
BM Okay, thanks. First, I wanted to clarify, Mike, about Tanzania. Do you believe there were cases of Ebola in Tanzania or are you saying there’s too little information to conclude? And then the second question is, back in the outbreak area, in DRC, how extensive do you think that there is… How extensively do you believe there is underreporting of cases in these new areas? In other words, how complete is the picture that you think you’re getting right now, of the number of cases?
MR Just to be clear, WHO is not saying that there has been Ebola in Tanzania. What we’re saying is the information we’ve been provided with has been incomplete to carry out a full risk assessment. And in that regard, we had asked that samples be shared with an international reference laboratory, and other things.
Having said that, there is… The Government have reported on a number of occasions now, that all samples in the laboratory have been negative, and there is no indication from the ground, at this point, of any unusual events or unusual epidemic activity in the country. We remain on standby to support Tanzania, and we surged staff into the country to accelerate preparedness in the country and are ready to respond if anything untoward were to happen. But, for the record, WHO is not saying that there has been Ebola in Tanzania.
00:23:07
With regard to how extensive the disease is in the new areas, certainly, the overall quality of surveillance has improved. Over the last 90 days, 90 days ago, the Director-General called on us internally, to really up our game, in terms of surveillance with the 30, 60, 90-day acceleration plan for surveillance and contact tracing.
And we’ve seen great success working with the Government of Congo and implementing that plan. The number of alerts has risen over the last three months, from about 1,500 a day to 3,000 a day. We’ve doubled our laboratory activity, doubled the number of teams in the field.
But you are correct, when you go into a new remote area, it can take a little time to get a handle on exactly where the populations are, and where the virus is. I believe in places like Mambasa, and most of Mandima, we have a very good idea, but in the areas of Lwemba and Biakato Mine, we still don’t have a full picture as to where the virus may be.
So, we don’t believe we are dealing with a catastrophic situation. The numbers are extremely low compared to before, but we don’t fully understand the dynamics of transmission in the Biakato Mine area, and that’s why the DG is expressing such caution regarding any over interpretation of the low numbers. Until we have zero cases, there is no zero risk.
00:24:35
TJ Thank you very much, Dr Ryan. Hope this answers your question, Betsy. We have someone else online. Again, I apologise, because we are not really able to properly recognise the names of the outlet of the journalist. Please go ahead. Hello, do we have anyone online?
PD I am online. Can you hear me?
TJ Yes please, go ahead and introduce yourself.
PD Yes, hello, hi, I’m Pam Das from the Lancet.
TJ Hello, Pam Das.
PD My question is… Hello. My question is, the PHEIC, what difference has declaring the PHEIC made to the response, both from the ground and internationally?
RS Okay, we have discussed that in the Committee meeting. Obviously, as the Director-General has alluded to, has been increased plans to detect cases rapidly, etc. However, let us just acknowledge the fact that the decrease of cases started long before declaring the PHEIC.
As you may remember, we did not declare a Public Health Emergency of International Concern at the first outbreak in 2018, in the Democratic Republic of Congo, and we also hesitated to declare a PHEIC originally in this current outbreak.
It was actually just when cases were noted in Goma, there was great concern that there might be possibly massive international transmission or massive increases of cases, in other countries, because of the close border to Rwanda. But essentially, just let me underline again, the decrease of cases started already before the PHEIC was declared. Does that answer your question?
00:27:07
PD Yes, so in terms of the PHEIC, the continuation of the PHEIC still being maintained, yes, cases are decreasing. The threat still remains as strong as it was when you declared the PHEIC?
RS As I mentioned, we have to be cautious. I think that all three of us have mentioned that there is a this risk may be a flare-up again, particularly if we have security problems in the new rural area. And security, for the time being, is not assured at all, and so it would certainly be wrong to stop the PHEIC condition right now. Let us maintain that until we are really sure that we are either at the zero cases or close to it.
PD Thank you. Just one more point to add, a question to add. In terms of funding, has the declaration of the PHEIC influenced donors in any way? Can you attribute the declaration of PHEIC to any changes in the funding environment or not really?
MR I think there’s a massive gap between the rhetoric and the reality. The declaration of the PHEIC facilitated and supported governments in accelerating their preparedness activities, and we’ve been working with partners, very hard with those governments. In that time, the SRP-4 calls for a $68million investment, which seems like a very small investment across nine countries for preparedness.
00:29:00
Of that, 4.5million is funded, as we speak, and we’re four months into SRP-4. So, to argue that the declaration of the PHEIC has in some way magically generated millions of dollars would be a massive overestimate.
TJ Thank you very much. I hope, Pam, that we answered your questions. We have one more journalist online willing to ask a question. That’s Liza Schnirring from CIRAP. Can you hear us?
LS Yes, thanks so much, and also thanks so much for addressing questions about the vaccine. I just had a real quick question for Dr Ryan. You mentioned that once it receives full approval from the European Commission, it might impact supply. I wanted to just check with you, to see if that could increase the supply next year, or I just wanted to make sure that I understand that point. Thanks so much.
MR Hi, and it’s good to have an opportunity to clarify. I didn’t mean impact negatively. I meant, impact positively. We are in the process of working with partners like Gavi on a global Ebola Vaccine Security Plan, in which we will be able to guarantee and ensure countries who may be affected by Ebola will have a guaranteed supply of Ebola vaccine. And thanks to all our partners, including the manufacturers, for working with us on that.
00:30:34
The fact that we will have a licenced product will allow, for example, African regulators to licence the product. It will reduce the burden and the prerequisites for vaccination. It will reduce the logistics. It will reduce a lot of the barriers to vaccination. It will also allow, obviously, the manufacturer to move into full-scale licence manufacturing production, and will also, potentially facilitate the subcontracting or sublicensing of that vaccine production to contract manufacturing organisations.
So, the general process of licencing will allow those processes to happen. So, it is our hope, and the Director-General has previously said in press conferences, that through his work and the work of others, with the manufacturing, with the Merck company, have already agreed to doubling the manufacturing capacity over the next year. And we hope that this licencing process will allow for further increases in vaccine production in the coming months and years.
LS Very helpful, thank you.
TJ Thank you, Lisa. We will now give the floor to Donald McNeil from the New York Times. Can you hear us, Donald?
DM Yes, I can hear you. Can you hear me?
TJ Yes, please go ahead.
DM I have two questions. One was, you mentioned that you have only received half as much money as you need for the response. Can you give us the amounts, what you need and what you’ve received so far? And second, do you have death counts for how many people have died of malaria and measles in DRC recently?
00:32:10
TJ Thank you, Mike, please?
MR I can give you the numbers on the funding needs. If we leave aside the preparedness in the surrounding countries, and we look at the core costs of the response in Congo, that will be the period July to December, and the Strategic Response Plan for covering public health, security, logistics, community engagement, non-Ebola interventions for building community confidence. The total ask on that has been about US$ 394 million.
Of that, US$ 126 million has been received by various agencies, including the World Health Organisation. The financial gap based on that is still of the order of US$ 267 million. Now, however, having said that, there is a lot of funding that has been pledged in the system, and in fact, our biggest problem right now is not the pledging of money.
It has been the disbursement of those funds, so they can be spent in the field. And we’ve been working very closely with the World Bank and have had teleconferences with them as late as last night, to look at how we can accelerate the disbursement of those funds from pledging agencies. But we are in somewhat better shape.
00:33:29
DM Do you have enough money or do you not have enough money? This money has been pledged, and the problem is dispersing, this is not a call for more money, is it?
MR It’s a call for… The funding is still not adequate. We’re certainly, and the DG has called for funding on the preparedness side, this situation is entirely different on the preparedness side. Funding being pledged is not a guarantee of funding arriving in time to make a difference in the epidemic. There’s a need to complete the funding that’s required.
There’s still a US$ 60 million gap in funding pledges, but the main gap at the moment is in turning those pledges into funding on the ground. And that is the biggest gap right now, in terms of the response. In terms of preparedness in surrounding countries, the major gap is a complete absence of pledges that are adequate enough to meet the preparedness needs. So, there are very clear differences between the two requests.
DM How big is that gap, for preparedness?
MR Sorry, I didn’t hear you Don.
RS How much?
RS The total needed is US$ 66 million and what we now have got is US$ 4.5million. So, it’s not close. Nothing close. Yes, so the problem here is that the world responds when there is panic, and I think with the current situation, people don’t see the sense of urgency. But the most worrisome part is, we’re not ready, as a global community, we’re not ready to invest in preparedness, to fix the roof before the rain comes.
00:35:15
I think investing in preparedness, as you can agree, Donald saves lives and saves money, and we know that, but we’re not doing that. And we’re saying, we have to do that. It pays off. If you compare the DRC and Uganda for instance, Uganda is better prepared now. It has been preparing for the last one year. When cases were introduced into Uganda, it was controlled immediately. That’s the result of preparedness. They saved lives and they saved money.
So, what we’re saying is, the value proposition here is, if you invest a small amount of money now, you can actually avert deaths, plus save money. And that’s the smartest approach to emergency response or preparedness, and that’s what we’re calling the world to really focus on and learn from our mistakes.
MR Just to supplement [overtalking] we’re looking for, we’ve had 20,773 cases of cholera since January in DRC. Over 200,000. 203,179 reported cases of measles, and with over 4,000 deaths, which is an incredible toll to think that 4,000 children have died from an utterly preventable disease in Congo this year.
And in DRC right now, nearly 50,000 people a year are dying from malaria, and again, that’s diagnosed malaria. So, I think when the DG speaks to the fact that these three diseases are taking a much greater toll in Congo than others, I think is borne out in the data.
00:37:15
RS Actually, Donald, maybe to put it in perspective. In the same period, measles killed double Ebola, double actually. 2,000 Ebola, more than 4,000 measles, and that’s why we’re saying, we have to invest in the health system. Not only that, the number of mothers dying because of complications during delivery is very high. Maternal mortality is very high in DRC and we cannot just focus on Ebola, but just for your information, we have vaccinated more than 3 million actually, for measles, and also 800,000 for Cholera.
So, we’re doing that, but because of the weak health system, still that will not be enough, and we’re losing many lives, more than Ebola, because of cholera, measles, malaria and complications during delivery. And many mothers, we’re losing, and of course, child mortality is also high.
TJ Thank you, very much for your questions, and thank you everyone for answering. I don’t see any other questions from journalists online, and no other questions from the room here, so we will conclude this press conference. Some big thanks again to Dr Tedros, Professor Steffen and Dr Ryan. We will have an audio file soon, and then we will also have a transcript from this press briefing. I wish everyone a nice evening and a nice weekend. Thank you.
00:39:00